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Finding a flaw is hard to do

Dr. Mark Miller has not fixed the country’s health care system from his solo family practice in Fayetteville. But he may have come up with part of the solution.

For the past 18 months, he’s been offering his patients this deal: For a $49 per month membership plan, they can see him as many times as needed at an additional $25 per visit, plus they get all tests at his cost. If the test doesn’t really cost him anything – for example, taking an x-ray with a machine he already owns – he doesn’t charge them a cent. He offers this choice to all his patients without asking about pre-existing conditions.

It’s sort of a one-doctor insurance company that’s designed for two groups of patients: the uninsured, and those who have high-deductible insurance plans. Of course, it doesn’t pay for the costs of seeing a specialist. However, he estimates that 90 percent of a person’s health care needs can be met by a family doctor.

He created the membership plan after reading about a clinic in Springfield, Mo., that was offering a similar deal.

The son of a jeweler, he considers himself not only a doctor but an entrepreneur. So far, more than 100 of his patients have signed up for the plan, so that guarantees him a net income of about $5,000 a month, plus he is paid $25 per visit, and he doesn’t have to mess with insurance.

How much is that worth to him? “Let’s say you have a $100 charge to insurance,” he said. “I might take $50 to $70 from a cash-paying patient and come out even.”

That gives us an idea of how much of the heath care system is devoted to the insurance payment bureaucracy, apart from the government’s payment bureaucracy. Any wonder why health care costs are rising?

Miller believes the only way the health care system will be reformed is by patients acting as consumers and considering costs just as they do in other areas of life. That means health insurance should protect assets, like home and auto insurance do, but not pay for minor expenses. Under his system, patients are at least exposed to costs – $25 for a visit, $7 for blood counts, etc. – that they understand at the time of purchase and pay when they leave the office.

For his system to work, he believes insured patients should have high-deductible policies, which take less from their paychecks but require higher out of pocket payments when care is provided. Along with those plans, patients need health savings accounts, which allow them to save money tax-free to use for medical expenses.

That means instead of paying a humongous check to the insurance company every month and then expecting everything else to be free or very cheap, the consumer is keeping most of that money and then deciding whether to spend it at the doctor’s office. He says that makes patients think twice before saying yes to a $500 MRI scan they don’t really need – but if they need it, they have the money because they haven’t been writing such big checks to the insurance companies.

Miller’s membership plan doesn’t just change his patients’ behavior; it changes his own. With insurance, he makes money one way – by getting patients into the office and then selling them care. With his members, he has another revenue stream. It empowers his patients. Now they aren’t just vehicles for billing insurance companies. They’re his clients.

In practice, that means if a patient calls into his office with the same bladder infection she had last year, Miller is less likely to make her set an appointment and then sit (uncomfortably) in a waiting room until he’s available. Instead, he’ll call the prescription into the pharmacy.

Why make her come to his office? She pays him monthly. He’d like for her to keep doing so.

“I’m on retainer for you, so I’ve got an incentive to call it in for you and make sure that you get taken care of,” he said. “I don’t have to get you into my clinic for me to profit and run my business off of you as a patient. It’s a great system. I’ve found no flaws in this system so far.”

It might seem strange to hear a doctor talking like a businessman, but doctors and hospitals are trying to make a profit like everyone else. Unlike in other businesses, today’s consumers have very little say in how they do that. Under Dr. Miller’s system, they do.

I can’t find a flaw in that either.

Steve Brawner is an independent journalist in Arkansas. His blog — Independent Arkansas — is linked at Arkansasnews.com. His e-mail address is brawnersteve@mac.com